The purpose of this study is to test and extend an investigator- developed, empirically supported Organizational Dynamics Paradigm of Nurse Retention. A Leadership Building Intervention will be used in four large urban hospitals to operationalize the causal pathways depicted in the Paradigm. Specific aims include documentation over time of the impact of the intervention on retention of staff registered nurses; exploration of the relationships of retention and absenteeism of staff nurses to patient safety and satisfaction outcomes; and examination of the associations between nurse manager personality characteristics and both effective leadership and retention of staff nurses. The researcher's long term goal is to facilitate better understanding of the relationships among staff nurse retention, absenteeism, and productivity, and of the impact of those variables on patient outcomes. Nurse managers of patient care units (N approximately 80) and staff registered nurses (N approximately 1800) compromise the samples for the study. A multi-group interrupted time series design will be used, with delayed intervention for two of the four groups. The Leadership Building Intervention is based on established, commercially available systems for effecting change in manager behavior, with appropriate customization and tailoring to fit the project. Baseline data on retention, absenteeism, and patient outcomes will be collected retrospectively for one year prior to initiation of the intervention, for the year required for implementation of the intervention, and for one year postintervention. Established measures with reported evidence of validity and reliability will be used. Data analysis will include both a "week inference" approach based on correlational data and a "strong inference" approach based on multivariate repeated measures analysis of covariance. Hypotheses to be tested relate to the impact of the intervention on intermediary causal outcomes as well as on staff nurse retention. Extension of the Paradigm to include patient outcomes will be explored using correlation and multiple regression procedures. Experts perceive that cyclical nurse shortage continues to occur nationally because of lack of attention to the working environment. Few, if any, studies have been conducted to document the effect of staff nurse retention and absenteeism on patient welfare. The proposed study will provide important information to address both of those problems.